Support we’re providing service users during the Covid-19 pandemic
Posted on 27, April 2020
The Covid-19 pandemic has brought about huge changes to all of our daily lives as we all make changes and follow advice from the Government and the NHS to try and limit the spread of the virus. As well as being a threat to our physical health the virus can impact our mental health causing stress and anxiety for ourselves and our loved ones around contracting it. That is added to by the restrictions on movement brought about by new rules on social distancing and lock down that puts increased strain on us as we’re unable to partake in activities that are important to our mental wellbeing like attending events, visiting shops or venues or just seeing family and friends.
All of the above applies to and can potentially be magnified for the people that use our services at Together who have previously experienced mental distress and may be living with a diagnosis. Of course dealing with the pandemic is different for every individual and that is something that is important for our organisation. Our core principle is service user leadership and we believe in the value of lived experience in the way we support people which includes both the experience of the people who use the services as well as our staff.
So as social distancing continues and news on the pandemic dominates a lot of charities have provided advice on ways people can manage their mental health and activities they can undertake. We wanted to provide tips and advice of our own but from a lived experience perspective and so we asked our staff around England to share with us the ways they are providing mental health support to the people who use our services. We provide four different types of service which includes accommodation, community support, advocacy and supporting people in criminal justice settings which means we work alongside a wide range of people and in varied situations. We hope the ideas and practices our staff share will be of use in taking on tips, gaining a different perspective or just to provide a bit of inspiration:
Sara Moylan, Northamptonshire Floating Community Support Service
Here in Northants intermediate service which is a community floating support service we are offering phone support and essential face to face contact to our service users.
Phone support is more regular for those that need it than their regular face to face support to ensure they are staying well and keeping up morale. We have even managed via phone and emails to support a service user facing homelessness into temp accommodation, she has now moved into this temp accommodation and is settling in and no longer at risk of homelessness.
The support workers before lock down did prep with their service users – setting up online shopping accounts, setting up online prescription orders, chemist deliveries – ensuring the service users have all the essentials to stay well. We have collected and delivered essential food parcels to service user’s door steps.
We have linked in with lots of voluntary services in the community and linked our service users in with these too. We have printed off adult colouring sheets and posted them to service users that are struggling with their mental health as this is in activity that they enjoy.
We have a service user that was accessing Maths and English courses via MIND and we have contacted MIND and requested they send some work sheets for her to work on while in social isolation to keep her busy as well as maintain her new found confidence.
Those service users whose children are now at home with them as schools are closed we have suggested free activities that can help support them, such as Carol Vorderman maths website and lessons, Otti from Strictly come dancing activities online.
For the team I am completing supervisions over the phone to ensure all staff are staying well and to keep up to date on all service users and needs. We have a team what’s app group which is on fire lately – from team members asking their colleagues questions on support for their service users, to sharing funny videos and photos to make us all laugh.
Sara provided a team photo which is from their last team day which was murder mystery:
Francesca Self, Social Inclusion Recovery Worker, Vanguard Court Accommodation Service, Norfolk Integrated Housing and Community Support Service (NIHCSS)
I thought I would share some of the ways we are supporting our clients at Vanguard Court (Norwich). I created an information sheet to hand out to service users giving ideas for them to keep busy and maintain wellbeing throughout this period. I have also done a sports quiz with a particularly vulnerable service user who is self-isolating; we took part together over the phone and compared scores at the end. I’ve also seen helpful tips for morning anxiety from Radio 1 and Dr Radha that I’m sharing with people.
My colleague Sarah is compiling a ‘boredom pack’ which will include crosswords, word searches and other activities that service users can complete. She is leaving these in the office for anyone to photocopy. Sarah is supporting a person to sign up to My Maths which is an interactive site which provides lessons online and also marks questions too. Sarah is following up with Skype maths lessons to supplement the work her that person is doing herself.
My colleague Luke has produced a newsletter for both in house and outreach clients with updates of how our support is changing, useful helplines, a poem from another local project and other useful information.
Staff are meeting with service users to go for walks when social distancing can be preserved. Namely the ones that would not be able to go out on their own without support. Staff have also been going to pharmacies and doing food shops for vulnerable people.
We’re all trying to be creative with different ways to support our service users and welcome feedback from them.
Steve Warburton, Independent Statutory Advocate, Rochdale Advocacy Hub
I am representing a patient with an appeal with regard to a Community Treatment Order. I have supported the process by engaging with the practicalities of sharing paperwork by supporting administration with the Law Office. I’m helping to engage across services involved although due to Easements within the Mental Health Act, it is likely that the patient will need to await a decision due to a delay in Tribunal dates.
Karen Trippier, Team Leader, Hampshire West Housing & Support, Eastleigh Hub
A quick update from Eastleigh Hub in Hampshire West. We are currently in our second separate period of isolation within our 5 bed shared supported accommodation house. That is also where our office is based, and under usual circumstances, where residents from our other less supported schemes would come for group activities and social / support session. We previously had a resident who had some symptoms, meaning the whole house had to isolate. They all came out of that period safe and well, but another resident has shown symptoms now so isolation has started again. One of the other residents is shielding and another is in a vulnerable group.
Prior to the pandemic, the residents of the house discussed at their monthly meeting that they would like to plant sunflowers in our garden this year for a sunflower race – and a trip to the garden centre had been planned for the end of March to buy seeds. Obviously this trip did not go ahead.
Given that they are attempting to cope with isolation and social distancing, we have now purchased some giant sunflower seeds online which are due for delivery any day. Staff will be supporting service users to each plant and label some seeds at “socially distanced” spacing (and the planting and care can be done whilst also observing social distancing). The idea is they can continue with the activity, have something to focus on and cheery to look at, and it will be a sunflower representation of social distancing! In addition the residents have decided to plant and label some seeds (and tend on behalf of others) for some residents from other projects and the community who would usually visit, and for two staff members, including myself, who are currently shielding and working remotely. Obviously there are no photos yet but these will be taken regularly as the plants grow. Also the timing is quite good as they should arrive at optimum planting time – so we are expecting good things!
Another piece of work about to start in the house, to help promote social distancing, is a creativity / fun activity where staff and service users are finding unusual or random things which measure 2 metres (such as a llama apparently!). They will then display pictures of these to demonstrate in a fun way what the safe distance is. We will obviously be obtaining photos over the coming week, and I anticipate many phrases such as (please stay one llama away from me!).
Jacqueline Carpenter, Project Manager, St Helens Community Support Service
As well as support plans and risk management plans we are completing Wellbeing plans with all our service users. These plans identify activities/hobbies they would normally do and the obstacles preventing them to now do this. We then discuss alternate ways or similar activities they can do whilst isolating or socially distancing themselves safely. We have found this useful to keep people focussed and enable them to be creative in planning their day.
Sally Forrest, Locality Manager, NIHCSS
This isn’t a service user intervention but certainly a staff one that has benefits. We have just had a conference call team meeting and it is one of the team members birthday. All the team sang Happy Birthday to them. I personally think it is worth saying that it is just as important to keep the morale of our staff up so that they are able to support service users at this difficult time.
Karen McIntosh, Social Inclusion Recovery Worker, Bakery Court Accommodation Service, NIHCSS
I thought l would share my ideas and suggestions when l am speaking to my service users on the phone and offering telephone support. I discuss how they have been and what they have been doing and then I always like to try and joke with them and say l have some homework for them.
The homework is normally to watch a TV programme. So for example, one of the people I work alongside is on the autism spectrum but loves crafting and today at 6.10pm there is a ‘Crafting at Home’ programme on for an hour. So I’ll light-heartedly suggest that’s her homework for tonight and then when l call her on Monday so we can talk about it. I also suggest to people they watch a comedy or lighthearted films. Like today on BBC2 they’re showing “Those Magnificent Men In Their Flying Machines” which is a good family watch together and quite funny. As everyone is staying at home I ask how they are but the conversation can get stuck. So l feel adding the element in jokingly of a bit homework lightens the mood and also gives me something to talk about, as in did they watch the programme and did they like it. Previous things I’ve suggested for homework are watching the Muppets and also Jamie Oliver when he is cooking from the pantry.
So each morning when l am having my cup of tea l have a look through the schedule to see if there is anything on l can recommend to the particular people l am phoning that day. I know that may sound like a small thing but l do feel it helps them and makes them laugh and they do say to me l am silly when l suggest it, but l don’t mind.
Roisin Whitely, Independent Statutory Advocate, Rochdale Advocacy Hub
I am supporting a service user with regard to issues with finance and am engaged by telephone with them after conversing with other practitioners who they’ve already spoken with. I have tried to carefully plan a positive engagement with the service user to reduce anxiety and have looked to increase their confidence by successfully encouraging them to share their wishes and values over the phone. I gave feedback to the service user to provide clarity in line with their preferences and promptly shared their wishes with the relevant person who will be leading on decisions for them. It was extremely important for me to coordinate communication across a variety of services to ensure that the service user’s voice was evident in the decision making process.
Gemma Granville, Project Manager, Elva Court Accommodation Service
At Elva Court we produce weekly newsletters that helps us keep service users up to date during these uncertain times! Elva Weekly has input from both service users and staff.
Jo Jones, Team Leader – Acting Locality Manager, Boudicca Court Residential Service, NIHCSS
At Boudicca Court we have weekly Car-park Bingo. We are starting a movie night tonight in the car park as well as we were donated a 90” screen and loaned a projector and this will be done weekly. We are also having a coffee morning/quiz in the car park each week starting next week, organising a social distancing walking group and a weekly comedy evening so Monday to Friday the residents have something each day.
Dan Cooper, Project Manager, Clifton House Accommodation Service
In terms of different ways we’re helping service users adapt to the coronavirus we’re ensuring we’re available and asking questions about what residents understanding is of the protocols and explaining why this is being asked of them. Our staff are modelling appropriate actions such as correct hand washing so residents are able to observe this in action. We’re having individual discussions with residents where they are not observing protocols around social distancing and fostering a sense that they are supporting themselves and others when they take the appropriate actions.
To try and help with managing stress and anxiety we’re having regular conversations with residents to explore how we can support them effectively and looking at positive events that are still going on and putting these on our notice board. We continue to operate our daily morning movement classes for exercise and wellbeing and accompany residents for walks at appropriate distances so they can get out and stay active.
There is an increase in opportunities for activities such as board games and table tennis and also gardening. We are preparing each resident an organised box so if they do have to go into self-isolation they will have things to entertain and comfort them such as favourite snacks, books and films. We’re also taking in specific requests from residents for foods (such as steak) so they don’t have to go out and buy it for themselves and placing it on our twice weekly home deliveries.
In terms of our own staff and how we’re managing our own wellbeing, we practice regular meditation and exercise. We try to return to right now and to the reality that everything is OK right now, and that the fears are in the future and are not real. Eating well with fruit and vegetables always helps and we have regular check in’s between the team to see how we are doing and if all is OK. We’re continuing supervision as an opportunity to discuss the current situation.
Deborah Adewole, Project Manager, Forensic Mental Health Practitioner Service
In terms of my own wellbeing and my family the lock down has allowed us to do the things we always want to do but never get around to. We have played board games like Ludo and started gardening. My 4 year old has taught me to ride a scooter so we can do that together as our daily exercise and we have done a ridiculous amount of cooking and baking. And eating of course. I don’t think we’ve ever eaten so many lovely meals to be honest and that’s because we simply have a little more time to do it all.
Brittany Hanson, Independent Statutory Advocate, Rochdale Advocacy Hub
I am representing a service user who has moved from supported living to independent accommodation. I’ve built a positive relationship with the service user via phone and text and they shared with me that it was difficult to access money from their appointee. Two payments a week were arranged and I thought this arrangement put the service user at risk from infection if more than one shopping trip was needed weekly. I contacted the appointee (Local Authority) and now the payment has changed to accommodate the service user’s need for one shopping trip per week. I’m pleased to say I continue to have enjoy a positive relationship with both the service user and the appointee.
Rose Trampe, Senior Social Care Worker, Clifton House Accommodation Service
We have opened a Tuckshop. The shop is open every day for half an hour. Normally we would provide healthy snacks and residents would go to the shops themselves for snacks, fizzy drinks, toiletries etc. Now residents can buy these (retail price) at Clifton house.
We have ordered lots of indoor games. Staff and residents will play these together at least twice a day. We have ordered games for the garden too.
Of course we do a lot more and things are all different now, but I think these points are what is working well with our residents.
Cristina Pastor, Senior Social Care Worker, Kings House Accommodation Service
Our service had to re-adapt quickly to the new climate of Covid-19 and lockdown. We have realised how much technology is our friend and we managed to have even staff evening gatherings on platforms such as Zoom, outside work of hours for social gatherings that is. This allowed a lot of us to see each other and have some chats and relax after work. We also used platforms such as DUO for both staff and residents to talk to remotely placed staff or to their relatives. This allowed staff to still keep in contact from home with residents but I guess this is nothing new or creative.
We also tried to involve the service users in spreading awareness of the Covid-19 dangers and good practices. Some residents, particularly one, has many times been a champion of safety around COVID-19 for the other residents. This has helped staff a lot in their effort to educate. I’m sure all of our services had to adapt to various individual barriers and work around them the best they could.
Moni Noszkay, Project Manager and Independent Statutory Advocate, Rochdale Advocacy Hub
Supported by Roisin from our team, I’m presently offering independent statutory advocacy to a vulnerable individual who has been assessed as being on the Autistic Spectrum. The service user is struggling to understand the reasons for and the impact of lockdown and it has substantially affected their routine and caused distress. The individual has an addiction issue with alcohol and has been consuming a regular amount each day. Part of the service user’s routine is to walk to the shop once a day and their care plan supports an agreed amount of alcohol. The Service User also has issues with the sensory impact of soap and water on their own skin.
Together with Roisin, I attended a Multi-Disciplinary Team Meeting involving 8 professionals from other organisations and the individual’s mother on a Skype Conference Call. The discussion was to review a Protection Plan to support the service user to continue daily activities without restrictions, as safely as possible. Covid-19 legislation states the need for essential journeys is appropriate, it is considered that the service user requires this journey and it is essential as part of their routine. The team involved will ensure the service user is not restricted but is kept safe when out in the community.
The outcome was to engage a plan to remind support workers to request that the individual uses hand gel when he gets back from the shop. A Social Story will be prepared by Community Team for Learning Disability to encourage understanding about the 2 metre social distancing rule.
Terry Hayden, Community Link Worker, London Criminal Justice Forensic Service
Many of the service users I work with have been self-isolating for a while, and long before the current COVID-19 pandemic had hit the world like a bull in a china shop. This can be for a variety of reasons, quite often as they are unable, or simply don’t want to connect with the ‘real world’, due to poor mental health, or a whole raft of other psychological or social issues.
As someone who attempts to help and support those often very vulnerable people, those who are often marginalised by society, I now have learned much about the feelings of isolation, the troughs and pitfalls of being stuck inside, unable to get out and interact with a world that now seems so distant to me.
Not being able to go out to a shop, the feelings of terror at the thought of leaving the house, our ‘safe haven’, the place we find solace, the place we can draw the curtains and shut everything out. These have now become a reality to me and thousands of others, things that we have taken for granted for all our lives, we can now start to have a glimpse of the world of those who have been battling this type of isolation for years.
Prior to this current situation, I could express empathy with my clients about going out, and could suggest strategies to help them venture into the sometimes cruel world. It is only now, having experienced the closed curtains myself that I can fully appreciate the importance of that social contact that is denied to some, and just downright scary to others.
I now find myself talking to service users on the phone, no longer suggesting that they try to get out, albeit using baby steps, but instead suggesting they use things like games consoles to help distract themselves. That’s something only a few short weeks ago I would have been suggesting to do only in moderation.
The fact that we are all stuck inside together almost brings a oneness to us, to the people I work with. They can understand that I too am inside. We can talk about how we are coping and how we can support each other and indeed some clients have given me ideas during these difficult times. Working practices may have changed but the support we give to the people who use our services has not changed, the only difference is that now we have some insight into an often complicated world.
Adrian Tarka, Peer Support Coordinator, Offender Personality Disorder Pathway, London Criminal Justice Forensic Service
In helping peer supporters work with clients during this period of social distancing it has been important to continue to provide the clients with options. In working as part of a service user led organisation and understanding that provision is made according to the wishes of the individual, one choice has been ensuring that people have flexibility over whether they chose to communicate via text or phone call. I appreciate that different people have varying coping strategies for potentially distressing times such as the one we find ourselves in as a result of the Covid-19 pandemic. I am also aware that where some people might prefer to hear the sound of someone’s voice for emotional support, others may prefer a quick check in via text. In debrief conversations with peer supporters I have learned that both methods of communication are in use during this time with preference specified by the person themselves.
I have found it useful to use reassuring language with the peer supporters whilst communicating during debriefs following their service user contact. Acknowledging that this is a period of adjustment for service users, peer supporters and Together staff as a whole has helped to create an environment of mutual support and interdependence for all involved in the peer support service. I would expect that this will encourage peer supporters to communicate openly with myself in the event that they have any additional concerns brought about by social distancing and this new method, albeit a temporary one, of working with service users.
I have personally found the maintenance of a personal routine on a daily basis helps to sustain a sense of normality. I also appreciate the opportunity to communicate with colleagues over Microsoft Teams whenever possible in order to bring some semblance of personal feeling to interactions.
Nigel Lobley, Advocacy Operations and Development Manager, Rampton Hospital Independent Patients Advocacy Service
Please see below some examples of how we’ve managed to adapt the way we are providing advocacy support to patients in secure settings. Advocates would normally be hospital based spending much of their time on wards meeting with patients in person but given the current Covid-19 situation this is not possible.
High Secure: Patients are able to call the service to speak an advocate directly who can then offer telephone support and discuss any issues or concerns they may have; they are also able to write to the service but do not have access to email. If the advocate is unable to resolve the issue immediately they are able to contact the relevant professional or department by phone or email on behalf of the patient in order to find a resolution and feedback accordingly. For those who are not able to access the phone we have seen an increase of telephone or email referrals from nursing staff made on the patients behalf. This is quite a change in the way patients have usually looked to contact advocacy and shows how they are adapting to the situation. We have set up a weekly telephone advocacy drop-in session for the deaf unit where patients are able to access the service by phone via an interpreter on the ward.
Other secure services and CAMHS: We have been able to set up remote access to emails for advocates to ensure referrals are quickly acted upon and they are able to check the answer phones remotely if not in the office. We now have dedicated advocacy mobile numbers patients can call or text directly and have also enabled Skype so that individuals who are able to access the relevant technology can talk face to face with an advocate. Advocates make regular contact with nursing staff, clinicians and managers across services. That allows them to glean feedback, updates and details of any individual or collective issues or concerns they can help in resolving but also to remind patients we are still here and available. We are now remotely joining meetings such as Individual Patient Reviews (IPR), Care and Treatment Reviews (CTR) and Multi-Disciplinary Meetings (MDT) to ensure the voice and views of the individual are heard and challenge decisions on their behalf when required and appropriate and act as an additional safeguard.
Emma Starr, Acting Project Manager, Avalon Accommodation Service
To help the people who use our service to adapt to the coronavirus we have regular briefings/updates as and when new advice and information is given by the Government. We have created signs which we have posted throughout the project to remind all of social distancing and hand washing. Information about coronavirus in regular and easy to read formats is available for all to read and one to one advice and support is given as required.
While daily routines and external activities have all been disrupted, staff have been supporting service users to adapt to the changed circumstances. Service users have been getting involved with ensuring the property is kept well stocked by buying essential household items for the Project when out shopping. Some service users are making use of local takeaway/delivery services for some of their meals instead of going out to eat.
Avalon is currently running a variety of ‘in house’ activities to offer some sense of normality and ‘light relief’ to the current situation. Examples of these are:
- ‘Ad hoc’ art sessions in the garden
- Poetry readings also outside
- We are also offering a new activity, bingo, which is funded by SUIT and was very well received
One service user has been doing some ‘Light gardening’ and we are planning to organise a breakfast club session with breakfast supplied by a local cafe. We are also in touch with a local musician who is composing a piece of music for our forthcoming Relaxation sessions. That will benefit both service users and staff.
In terms of our own team and what we’re doing to manage our wellbeing, we have regular contact with our Operational and Development Manager and that has been invaluable in providing advice and practical support. Examples would be in signposting to relevant resources and ordering PPE for the Project. We have adopted a flexible working pattern to enable staff to work round the limited public transport service and or other responsibilities.
With staffing, we have been able to fill in any gaps with either Avalon established staff or Relief Workers.
Paul Richardson, Community Link Worker, Forensic Mental Health Practitioner Service
Covid-19 and social distancing has changed the way myself and the rest of our community link team work straight away because we are working from home. That’s not something I’m too keen on if I can avoid it as I prefer not to blur the lines between my work and home life where possible. To do this I’ve been making sure I stick to the same routine I have when I work which involves getting up very early for a train into London from where I live. This means some of my colleagues have gotten used to having a few emails from already when they open their inbox in the morning.
Being present in courts and in police stations physically is also a big part of the work that we do. We work closely with other professionals from the police, judiciary and other charities building relationships and working collaboratively and while we can still do that over the phone and online, it is better in person. We want to be able to work alongside any person that comes through the criminal justice system who could benefit from our service and that may be impacted by remote working despite our best efforts. Our Community Link Worker service has come on a long way and we’re proud that a lot of referrals lead to beneficial outcomes for service users so we want to maintain those standards.
We have still had some outcomes I’m really pleased with despite the restrictions we’ve faced with social distancing and lock down. The first of those was a service user who was in prison for 6 years previously and we supported from being homeless to securing supported accommodation for 2 years. We had to conduct all the final agreements via phone and ensure all the arrangements were made with the other agencies involved. I had an email from the probation officer to say how important Together had been in finding the resolution so that was satisfying.
In another case there was a person who’d worked all his life as a builder and bought a van from a couple for work and unbeknown to him or the couple it had been reported as stolen. The police acknowledged that the service user didn’t know it was stolen but needed to impound the vehicle along with his tools and that meant he was unable to work as replacing them was too expensive. Being unable to work meant he had bailiffs and money collectors coming which cause a lot of stress and anxiety. Despite not being able to use the organisation I’d usually work with because of demand in the current situation I managed to set him up with a debt management plan with an alternative firm. One of the ways I sometimes help people who may be experiencing anxiety around matters like this is offering to help them with opening mail they receive which can be daunting and stressful. I’d usually do that in person but in this case I talked the service user through it on the phone and helped them through that process. The person is really happy and told me they had the first proper night’s sleep they’d had for 6 weeks this week which is great to hear.
The final case I’ve been working on during this time is a joint case with my colleague Justyna and concerns transgender person who we’re concerned may be involved in modern slavery. The person is vulnerable and we’re collaborating with specialist teams that provide support around chem-sex as the person may be being forced into prostitution to potentially pay for a gender reassignment operation. I have been providing support around sexual health to the service user as well as information about covid-19. Justyna managed to secure accommodation for the service user in a hotel working together with Shelter after day centres were shutting because of the lock down.
Wendy Wilson. Independent Statutory Advocate (ISA) with Wakefield Advocacy Hub
Usually as an Independent Statutory Advocate (ISA) I would meet with the person face to face and it’s important due to difficulties with communication for someone who is assessed as having Cognitive issues that impact on their ability to make serious decisions. However, at present I’m not able to meet with a service user due to the Covid-19 pandemic and the closure of Care Homes and Hospitals at the moment. As a result I am developing further skills to engage with people who find it very difficult to communicate their wishes, values and feelings. Confirming and communicating that information is vital for me as the ISA to ensure the cared for service user is at the centre of decisions made on their behalf. The Mental Capacity Act 2005 ensures that cared for service user’s options are discussed at a Best Interest Meeting and I represent the person at this meeting.
I’ve been able to use skills I have as an active listener together with my experience to enable and encourage engagement with the service user who has great difficulty in communicating needs and wants. I took time to understand how I could engage the service user on the telephone. This was not easy to do as the person has a brain impairment which impacts on their ability to verbally feedback, or to understand, evaluate or retain information. I was able to establish the service user’s wishes and feelings so they could be fully informed when joining a video call for the Multi Disciplinary Best Interest meeting. It was extremely important for me to ensure I shared the wishes and values of the cared for service user in the meeting rather than my own considerations on behalf of them.
The Outcome was that I managed to share the service users own considerations, alongside their rights. The decision maker was then able to make the right choices with information shared by me and the appropriate representation was made on behalf of the service user.